PSYCHOLOGICAL AND METHODOLOGICAL ISSUES IN SUBSTANCE ABUSE TREATMENT/RESEARCH

物质滥用中的心理学和方法论问题 作为临床的一部分，治疗/研究正在进行调查 评估可卡因和阿片类药物滥用治疗的试验。某一领域 重点是改进监测可卡因使用的方法，以增加 临床试验发现有效治疗方法的能力。 定量尿液分析和新开发的鉴定标准 新的可卡因使用作为可卡因使用的替代措施进行了评估。 在未治疗的可卡因剂量研究中收集的尿样- 对寻找对象和可卡因治疗试验进行了分析 可卡因代谢物苯甲酰ecGonine，定性和定量 方法：研究方法。药代动力学标准(“新用途”规则)应用于 确定新的可卡因使用场合的量化数据。结果 在实验室研究中与已知的可卡因给药进行了比较 以及对受试者的自我报告药物使用和尿液定性分析 在临床试验中。正确识别可卡因的新使用标准 除少数外，所有可卡因剂量研究中的给药 标本的数量。在临床试验中，定量尿液分析和 估计的新用途提供了有关模式和 在不同的治疗方法中使用频率比定性尿检高 临床试验中的条件。对数量的解读 使用新的使用规则进行尿液分析似乎是一种有用的方法 监测治疗结果，可能比传统方法更准确 尿定性分析在估计可卡因使用频率中的作用。这 临床试验中正采用程序作为结果衡量标准 在全国各地。监测药物使用的其他方法也包括 正在接受评估。这些方法包括汗斑和定量 可卡因的尿检。关注的第二个领域是 有吸毒家族史。迄今为止的结果表明，阿片类药物- 患有共病精神障碍的依赖患者是 可能有一位父母患有物质依赖障碍或以上 有兄弟姐妹有物质依赖的可能性要高三倍 与阿片类药物依赖患者一样，他们没有合并精神障碍。 这些结果表明，精神疾病的共病与 以及物质依赖的家庭影响。其他研究 正在评估测量渴望和预测因素的方法 治疗结果。

Psychological and methodological issues in substance abuse treatment/research are under investigation as part of the clinical trials evaluating cocaine and opioid abuse treatments. One area of focus is improving methods of monitoring cocaine use to increase the ability of clinical trials to detect effective treatments. Quantitative urinalysis and newly developed criteria for identifying new cocaine use were evaluated as alternative measures of cocaine use. Urine specimens collected in a cocaine dosing study in non-treatment- seeking subjects and a cocaine treatment trial were analyzed for the cocaine metabolite, benzoylecgonine, with qualitative and quantitative methods. Pharmacokinetic criteria ("New Use" rules) were applied to quantitative data to identify occasions of new cocaine use. Results were compared to known cocaine administrations in the laboratory study and to self-reported drug use and qualitative urinalysis for subjects in the clinical trial. New Use criteria correctly identified cocaine administrations in the cocaine dosing study in all but a small number of specimens. In the clinical trial, quantitative urinalysis and estimated New Uses provided more information about patterns and frequency of use than qualitative urinalysis in the different treatment conditions in the clinical trial. Interpretation of quantitative urinalysis with New Use rules appears to be a useful method for monitoring treatment outcome and may be more accurate than traditional qualitative urinalysis in estimating frequency of cocaine use. This procedure is being adopted as an outcome measure in clinical trials around the country. Other methods of monitoring drug use are also being evaluated. These methods include sweat patches and quantitative urinalysis of cocaine. A second area of focus is on the impact of family history on drug use. Results to date suggest that opioid- dependent patients with comorbid mental disorder were over twice as likely to have a parent with substance dependence disorders and over three times more likely to have any sibling with substance dependence as were opioid dependent patients without a comorbid mental disorder. These results suggest a relationship between psychiatric comorbidity and familial influence of substance dependence. Additional research is underway to evaluate methods for measuring craving and predictors of treatment outcome.